妇产科学课件胎盘早剥英文版VIP免费

PlacentalabruptionDefinition–Occursafter20thweeks,prematureseparationofthenormallysituatedplacentabeforedeliveryoffetusIncidence:inabroad:1%-2%inourcountry:0.46%-2.1%.Thefetalmortalityisdependingonthedegreeofseparation.Placentalabruptionisaseverecomplicationoflatepregnancy.Itisalsoasignificantcontributortomaternalmortality.peelsawayfromtheinnerwalloftheuterusbeforedelivery—depriveofoxygenandnutrientsofthefetus—heavybleedinginthemother.—motherandbabyinjeopardy.Etiology(1)vascularlesion：PIH,especialseverepre-eclampsia,chronichypertension,chronicrenaldisease---vascularsclerosisspasm---Localvascularinjury---vascularruptureintodecidualbasalis---bleeding,hematomaformation---shearsoffadjacentdenudedvessels,separationoftheplacentafromtheuterinewall.producingfurtherbleedingandenlargingtheseparatedareaEtiologyuterinevenouscongestion---suddenriseinuterinevenouspressuretointervillousspace---congestionorruptureofvenousbed---hematomaformation---separationofplacentaanduterinewallEtiology(2)Suddenuterinedecompression：•prematureruptureofmembrane(especiallythepretermPROM)•thefirstfetusisdeliveredrapidlyintwin.•amnioticfluidflowedrapidlyinpolyhydramnios,theuterinecavity’spressuredecreasedsuddenly,uteruscontracts,whichcausetheseparationoftheplacentaanduterus.Etiology(3)Mechanicalfactors:•traumaorinjurytotheabdomen•shortumbilicalcord(absoluteorrelative)•Inamniocentesis,injurethevesselintheattachmentofplacenta---hematomabehindtheplacentaformation---separationoftheplacentaanduterinewallPredisposingfactors•Previousplacentalabruption.•Advancedmaternalage•Multipara•SmokingPredisposingfactors•Abnormalmetabolism•Predisposingthrombosis.•Uterusmyoma.•drugabuse.PathologicalchangesbleedingtodecidualbasalishematomaofretroplacentaSeparationoftheplacentaanduterinewallRevealedorexternalbleedingthecomplicationsarefewerandlesssevere.Smallamountbleedingandquicklycease.Noobvioussymptoms.concealedorinternalplacentalabruptionThehemorrhageisconfinedwithintheuterinecavity,detachmentoftheplacentamaybecomplete,andthecomplicationsareoftensevere.MixedbleedingconcealedorinternalplacentalabruptionTheplacentamarginalincompleteUtero-placentalapoplexy(Couvelaireuterus)•theplacentalmarginsremainadherent,hemorrhagethatinfiltratestheuterinewall.•Uterinetetanyfollows•extensiveintramyometrialbleeding---purplishandcopper-colored,ecchymosis•losesitscontractilepowerbecauseofdisruptionofthemusclebundles.DIC(disseminatedintravascularcoagulation)•Themothermaythendevelopawidespreadpetechiae,activebleeding，shock,andfailureofthenormalclottingmechanism.•Acuterenalfailure：acuterenalcorticalandtubularnecrosis.thromboplastinfromthevillianddeciduaofthestrippingsideMother’scirculationActivatebloodcoagulationsystemMicro-thrombosisincapillaryofthelung,kidney.IschemiaanddysfunctionoftheorgansagglutinantMother’scirculationActivatefibrinolyticsystemFDPHyperfibrinolysisDICEnterintoEnterintoformsecondaryConsumebloodcoagulationfactorClinicalfindingsanddiagnosis•patient'sreportofhersymptoms•physicalexaminationperformed.•testedtoevaluatethepossibilityoflife-threateningproblemswiththemother'sclottingsystem.Symptomsandsigns•beginanytimeafter20weeksofpregnancy.•Classicsignsandsymptomsofplacentalabruptiondependingonthesiteandextentofbleeding,thereare3grades.•clinicalfindingscorrespondtothedegreeofseparation.•Abo...